FORM 1023-EZ for RODRIGUEZ BOXING CLUB INC

Field Data
EIN 47-3252863
Case Number EO-2019284-000693
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name RODRIGUEZ BOXING CLUB INC
Organization’s Mailing Address 130 WARD DRIVE
City POCATELLO
State ID
ZIP 83202-1848
Accounting period End 12
Primary contact name JAMIE RODRIGEUZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LUIS ANGEL TAPIA
DIRECTOR
4317 OPAL AVE APT 27
POCATELLO ID 83204

Officer/Director/Trustee Two

JAMIE RODRIGEUZ
DIRECTOR
5245 HEATHERWOOD DR
POCATELLO ID 83204

Officer/Director/Trustee Three

GARTH LAMBSON
BOARD MEMBER
4601 MT PARK ROAD
CHUBBUCK ID 83202

Officer/Director/Trustee Four

BLAKE PETERSEN
ADMINISTRATOR
4601 MT PARK ROAD
CHUBBUCK ID 83202

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/25/15
Organization Incorporation State ID
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N31 - Community Recreational Centers
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name BLAKE PETERSEN
Signature Title ADMINISTRATOR
Signature Date 10/9/19

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